HomeMy WebLinkAbout2003 - Above Ground Fuel Tank
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Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville, CT 06382
(860) 848-3030, Ext. 382
Mechanical Permit
Permit Number: M2003-0054 Date: 24-Apr-03 Map/Lot: 096/110-000 Owner ID 4502
Job Location: Z L~Q~~RT Unit
Job Description: Install new fuel tank above round
Owner: Contractor:
Lu Fu Zhao and Qiu Xiang Qian Service Station Equipment Inc.
33 Leffingwell Road
7 Baldwin Court Uncasville, Ct. 06382-
Uncasville CT 06382 Telephone: (860) 848-2278
Lic/Reg Type/No. P9 208469 Exp Date: 31-Oct-03
Tenant:
Self
Telephone:
Construction Values Permit Fees Construction Information
Building Value: $0.00 Building Fee: $0.00 Use Group: R4
Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO
Mechanical Value: $850.00 Mechanical Fee: $10.00 Construction Type: 5B
Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R5
Other Value: $0.00 Other Fee: $0.00 Comments:
Total Value: $850.00 CO Fee: $0.00
Plan Review Fee: $0.00
State Ed Fee: $0.14
Total Fees: $10.14
rt the owners responsibility to schedule the following inspections (minimum 48 hours notice required):
❑ Footing - Prior to pouring concrete ❑ Rough HVAC
❑ Backfill - Footing drains and waterproofing ❑ Fireplace Throat
❑ Concrete Slab - Prior to pouring concrete ❑ Chimney - One flue above thimble
❑ Rough Framing ❑ Firestopping/draftstopping
❑ Rough Electrical ❑ Insulation
❑ Electrical Service ❑d Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signature:
-44Z
Town of' ontville
4Buildidg Department Permit
310 Norwich-New London Tpke.
Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231
One & Two Family Trades Permit Application Form
[@Pfumding F~Electricaf F Mechankaf
Heating
Air Con4tioning
Gas Oping
]Other
Job Location J34i-J W i all C- y N GAS O L LEr 6--r rJ 6 3 9-Z
Job Description/Materials 2NS rh'4- rI AJEW 3~ 7 S 6HLc.oxc/ No. 2, FucL QI L Rs7
JAGc-~fi -I-Z> RE~ OF J ~oc~ E
Owner Om L0JY Mailing Address 68' W IL(-J&,'15 5~
City 0 N G rJ State C- Zip 0 63 Z 0 Tel 8ta / ~-V / 7-$0
Contractor SSL , ~ Mailing Address 3,3 L6441NGw&"u 2-6, 9
City ~11~iC S ✓/c L c State ~T Zip d 6 3 Fs 2 Tel S-6 o
Contractor's License/Registration Type & Number 2- 464 Exp. Date 10
I hereby certify that the proposed work will conform to the Basic Building Code and all other codes as adopted by the
State of Connecticut and the Town of Montville and further attest that the proposed work is authorized by the owner in fee
and that I am authorized to make application for a permit for such work as described above.
Owner /Agent Signature Date d_I /6 / C> 3
Construction Value Fee
Building $ $
Plumbing $ ~5° ✓ $ r~
Mechanical $ $
Electrical $ $
Other $ $
Certificate of Occupancy $
Plan Review Fee $
State Education $
Total $ $ `
- Receipt
Town of ntvil►e Building DePartmer~
s
No.
k Date 1 l _
't From: ~
Job Address:
~ Check #
Cash Chcck'
Amount (~'i«ic one)
Permit
Received by
ervice Station
Equipment
Inc. - Specialties; Gas Pumps - Lifts - Self Service Specialists
38 Leffingwell Road Sales, Service & Installation
Uncasville, CT 06382
_i
(860) 848-2278 - 1-800-801-TANK
MOWN
Date (/~Z60 3 a . rwa.. _ .
PLUMBING & PIPING LIMITED CONTRACTOR
MARTIN D MCKINNEY JR
RFD #18 TOTEM LN
GRISWOLD, CT 06351'
City/Town NTU/CC C, C r TYPE: P9
UC.JREG N0. EFFECTIVE EXPIRES
RE: Applicant" for Plumbing Permit 208469911!01/2002 10/31/2003
SIGNED
Licensed contractors, as defined in section 20-338b of the Connecticut General Statutes,
Must personally sign each building permit application. This letter authorize the below
Named agent to sign the above referenced permit application.
Project Name LIM Lwy
Address: 7 P544-bw,1eJ c ~yl~T
V, JGRsV1CC64r_ 0.638Z
Staring Date:
S'
Licensed Contractor's Name: Martin D.Mckinney, Jr.
License Number : 00208469 - - - - -
International
r- Conference of Building Officials
Agent Name: JUt w r'y~P099 MARTIN D MCKINNEY JR
Is CERTIFIED In
UNDERGROUND STORAGE TANK
UECOMMIsSIUNING
The Individual named hereon is CERTIFIED in the category shown,
"Tanks A lot" ex suantlto successful completion of the prescribed written
Expiration date: July 11,1003
ICBO No.5073836.16
ASI No,.32026243
4oquip r Not v ilea 3 ass s gne t ca e o er.
erVl ent, Inc. IC8O Certification attestsoff competent kn v edg8e of codes and standards.
Applicable experience should be verified by local jurisdictions.
DATE (MMIDDIYY)
~CORO~ C RTC I~ ~ Uf= !.LIABILITY INS.%00
10/29/02
I
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BYRNES AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
553 HARTFORD PIKE, ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO BOX 739 COMPANIES AFFORDING -COVERAGE
DAYVILLE CT 06241-0739 COMPANY -
A VIRGINIA SURETY
INSURED COMPANY
SERVICE STATION EQUIPMENT INC B
COMPANY
33-59 LEFFINGWELL RD
UNCASVILLE CT 06382 COMPANY
D
i
COVERAGES:, :,:.:;'::[:iii'.;:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WilICH TH!S
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTA ! DATE (MM/DDIYY) DATE (MM/DD/YY)
GENERAL LIABILITY :GENERAL AGGREGATE $
COMMERCIAL GENERAL LIABILITY PRODUCTS • COMP/OP AGG S
CLAIMS MADE OCCUR PERSONAL & ADV INJURY i b _
;OWNER'S 6 CONTRACTOR'S PROT I EACH OCCURRENCE S
FIRE DAMAGE (Any one fire) b
MED EXP (Any one person) S
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT b
MANY AUTO ~
i ALL OWNED AUTOS BODILY INJURY
S
i~ SCHEDULED AUTOS - (Per person)
HIRED AUTOS I BODILY INJURY
- I (Per accident)
NON-OWNED AUTOS I ~
IPROPERTY DAMAGE i$
GARAGE LIAB0.ITY AUTO ONLY. EA ACCIDENT S
j -j ANY AUTO i OTHER THAN AUTO ONLY:
i ! EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE
UMBRELLA FORM AGGREGATE
I OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND 8 0 2 0 0 2 2 0 7 5 6 8/25/ 0 2 8/25/03 X ORY L HITS ER
EMPLOYERS' LIABILITY EL EACH ACCIDENT S 1 0OL0 0 0
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ 5 0 0,_0 0 0
- PARTNERS/EXECUTIVE
OFFICERS ARE: I EXCL - EL DISEASE-EA EMPLOYEE $ 100, 000
OTHER I~
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER
- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF A IN PON T E COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZdD/ S
K' ckey KH A
ACORD 25 S 1195} OAC0R0 CORPORATION 191
Page No. of Pages
■ ~ ~d~> titi~~lrJ~\ ~ ,:,r..
SERVICE STATION EQUIPMENTf INC. 03 152
Residential Tank Specialists Lic.# 00208469
33 Leffingwell Road
Uncasville, Connecticut 06382
(860) 848-2278
Toll Free 800-801-TANK
DATE
PROPOSAL SUBMITTED TO E ^
W. k rn LY 4103
STREET JOB NAME
W iLLlR7Y15 17'
CITY. STATE and ZIP CODE JOB LOCATION
EW Loowo C-063W I N Cl tfNG4SV1! L GT O6 R
ARCHITECT DATE OF PLANS JOB PHONE
X --s' D2~uc
We hereby submit specifications and estimates for: Qpyta*L d- 15 5 O t W O IVD
jmsrAL -4 notJ o l~l New x75 G,9wonr RST PrDZRr.~tr- To RepA of Raise
-0 opr~hN AfxxWE PRtAm d- CoNTX-r FIRG nw-a OAL
NEW ;LIS GMJcw VEIMICAG) CV rr d
4 xNSTA-LL mao 01 IL.L enT' P1 hVJD P - GvA9C SSLI;~ 70 CrODE'
14 -,CN Ate- PEW G L FvC- L U N6 CONIJd:-r 70 FvK
IR&NrsPen up 7a .2Z s a4uoys rt_F wcLo ► L. F✓Ran1 OLD UST' 7a NG-Aj As 7-
P9-1 mir a- TMr- SysrL"
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its
26-R&-A-1106- WNLITLi,S 1RANSVQz51&)C 057- CPRa -F
i, }lAQ0 S L~j bGC RZrlltGL/40L 4- DISMSAt OW 2 9/.:a Q -'6Wt44
E RL'iPA9R baL ON, SGo E
We Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
pIVE ' S vn 6IGH-T HutJOR-6- 19'NO SWdyL1!1'FlV6' dollarst$ l~S^"
KT7XX
Payment to be made as foll s: T S
540 ON (a- L ,,4A CE &KhrVCG O tJ Th*JKK 2N7N OJAL'~ J~j 'T-a TAZ~
W cc ~L~'7p`r' ~St~~ In4ST~12. GAfLj a- VISA G4~,~3
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authoriz
manner according to standard practices. Any alteration or deviation from above specifications Signature
invoiving extra costs will be executed only upon written orders, and will become an extra
charge over and above the estimate. All agreements contingent upon strikes, accidents or QMF 15
delays beyond our control. Owner to carry fire, tomado and other necessary insurance. Our ote: proposal may be S
workers are fully covered by Workman's Compensation Insurance, withdrawn b it not accepted within days.
Acceptance of Proposal - The above pries, specifications
and conditions are satisfactory and are hereby accepted. You are authorized to do the Signaturyl-I
work as specified. Payment will be made as outlined above.
Date of Acceptance: k Signature
Q To Reorder.
600.2256380 or nebs.oom